Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2025-01-03T12:13:14.410Z Has data issue: false hasContentIssue false

3 - Recent Advances in the Endoscopic Diagnosis of Esophageal Cancer

Published online by Cambridge University Press:  08 August 2009

By
Anne Marie Lennon  and
Ian D. Penman
Edited by
Sheila C. Rankin
Anne Marie Lennon
Affiliation:
Specialist Registrar, Lothian University Hospitals Division, Western General Hospital, Edinburgh
Ian D. Penman
Affiliation:
Consultant Gastroenterologist, Lothian University Hospitals Division, Western General Hospital, Edinburgh
Sheila C. Rankin
Affiliation:
Guy's and St Thomas' Hospital
Get access

Summary

Introduction

Esophageal cancer is the seventh most common malignancy worldwide and has the sixth highest cancer mortality rate. It has one of the most rapidly increasing incidence of all cancers in the last 5 years and is associated with a poor 1 and 5-year survival in the UK.

Correct staging of esophageal cancer is essential for patient care. This not only gives a good indication of survival but also allows for optimum management of the patient. In patients with very early oesophageal cancer (Tis/T1m), local treatment with endoscopic mucosal resection (EMR) or photodynamic therapy can be considered. For those patients with more advanced disease (Stages IIB–III), many centers now advocate using neoadjuvant chemotherapy (OEO2) or chemoradiotherapy prior to surgery as this may improve survival. For those patients with metastatic disease (Stage IV), palliative treatment is appropriate.

Endoscopic imaging

Flexible videoendoscopy with biopsy and/or brush cytology is the gold standard investigation for the diagnosis of esophageal carcinoma. Endoscopy is more sensitive and specific than double-contrast barium meal for the diagnosis of upper gastrointestinal cancer, and when biopsy and cytology are combined, the accuracy of endoscopy for diagnosis approaches 100%. Rarely, in patients with pseudoachalasia and repeated negative mucosal biopsy, endoscopic ultrasound with or without fine-needle aspiration biopsy may provide supportive evidence for malignancy and a tissue diagnosis.

Type
Chapter
Information
Carcinoma of the Esophagus , pp. 28 - 43
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

C. Donnelan, D. Forman, and S. Everett. The epidemiology of upper gastrointestinal malignancies: current perspectives and projections of disease burden. In The Effective Management of Upper Gastrointestinal Malignancies, eds. Cunningham, D., Jankowski, J., and Miles, A.. (London: Aesculapius Medical Press, 2005), 3–21.Google Scholar
Blot, W., Devesa, S. S., Kneller, R. W., et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA, 165 (1991), 1287–9.CrossRefGoogle Scholar
Pera, M., Cameron, A. J., Trasteck, V. F., et al. Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology, 104 (1993), 510–3.CrossRefGoogle ScholarPubMed
Newnham, A., Quinn, M. J., Babb, P., et al. Trends in oesophageal and gastric cancer incidence, mortality and survival in England and Wales 1971–1998/1999. Aliment Pharmacol Ther, 17 (2003), 655–64.CrossRefGoogle ScholarPubMed
Medical Research Council (MRC). Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet, 359:9319 (2002), 1727–33.CrossRef
Fiorica, F., Bona, D., Schepis, F., et al. Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut, 53 (2004), 925–30.CrossRefGoogle ScholarPubMed
Dooley, C. P., Larson, A. W., Stace, N. H., et al. Double contrast barium meal and upper gastrointestinal endoscopy. A comparative study. Ann Intern Med, 101 (1984), 538–45.CrossRefGoogle ScholarPubMed
O'Donoghue, J., Waldron, R., Gough, D., et al. An analysis of the diagnostic accuracy of endoscopic biopsy and cytology in the detection of oesophageal malignancy. Eur J Surg Oncol, 18 (1992), 332–4.Google ScholarPubMed
Faigel, D., Deveney, C., Phillips, D., et al. Biopsy-negative malignant esophageal stricture: diagnosis by endoscopic ultrasound. Am J Gastroenterol, 93 (1998), 2257–60.CrossRefGoogle ScholarPubMed
Siewert, J. and Stein, H. J.. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg, 85 (1998), 1457–9.Google ScholarPubMed
Japanese Society for Esophageal Diseases. Guidelines for the Clinical and Pathological Studies on Carcinoma of the Esophagus, 9th edn. (Tokyo: Kanehara, 1999).
Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc, 58:Suppl. (2003), S3–43.
Sugimachi, K., Kitamura, K., Baba, K., et al. Endoscopic diagnosis of early carcinoma of the esophagus using Lugol's solution. Gastrointest Endosc, 38 (1992), 657–61.CrossRefGoogle ScholarPubMed
Yokoyama, A., Ohmori, T., Makuuchi, H., et al. Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining. Cancer, 76 (1995), 919–21.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Dawsey, S., Fleischer, D. E., Wang, G. Q., et al. Mucosal iodine staining improves endoscopic visualization of squamous dysplasia and squamous cell carcinoma of the esophagus in Linxian, China. Cancer, 83 (1998), 220–31.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Fagundes, R., Barros, S. G. S., Putten, A. C. K., et al. Occult dysplasia is disclosed by Lugol chromoendoscopy in alcoholics at high risk for squamous cell carcinoma of the esophagus. Endoscopy, 31 (1999), 281–5.CrossRefGoogle ScholarPubMed
Meyer, V., Burtin, P., Bour, B., et al. Endoscopic detection of early esophageal cancer in a high-risk population: does Lugol staining improve videoendoscopy?Gastrointest Endosc, 45 (1997), 480–4.CrossRefGoogle Scholar
Carr-Locke, D., Al-Chaws, F. H., Branch, M. S., et al. Technology assessment status evaluation: endoscopic tissue staining and tattooing. Gastrointest Endosc, 43 (1996), 652–6.Google Scholar
Canto, M., Setrakian, S., Willis, J., et al. Methylene blue directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett's esophagus. Gastrointest Endosc, 51 (2000), 560–8.CrossRefGoogle ScholarPubMed
Canto, M., Setrakian, S., Willis, J., et al. Methylene blue staining of dysplastic and non-dysplastic Barrett's esophagus: an in vivo and ex vivo study. Endoscopy, 33 (2001), 391–400.CrossRefGoogle Scholar
Canto, M., Yoshida, T., and Gossner, L.. Chromoscopy of intestinal metaplasia in Barrett's esophagus. Endoscopy, 34 (2002), 330–6.CrossRefGoogle ScholarPubMed
Kiesslich, R., Neurath, M. F., and Galle, P. R.. Chromoendoscopy and magnifying endoscopy in patients with gastrooesophageal reflux disease. Useful or negligible?Dig Dis, 22 (2004), 142–7.CrossRefGoogle ScholarPubMed
Wong, R., Horwhat, J., and Maydonovitch, C.. Sky blue or murky waters: the diagnostic utility of methylene blue. Gastrointest Endosc, 54 (2001), 409–13.CrossRefGoogle ScholarPubMed
Wo, J., Ray, M. B., Mayfield-Stokes, S., et al. Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metasplasia and dysplasia in Barrett's esophagus: a preliminary study. Gastroinest Endosc, 54 (2001), 294–301.CrossRefGoogle Scholar
Egger, K., Werner, M., Meining, A., et al. Biopsy surveillance is still necessary in patients with Barrett's oesophagus despite new endoscopic imaging techniques. Gut, 52 (2003), 18–23.CrossRefGoogle ScholarPubMed
Meining, A., Rosche, T., Kiesslich, R., et al. Inter- and intra-observer variability of magnification chromoendoscopy for detecting specialized intestinal metaplasia at the gastroesophageal junction. Endoscopy, 36 (2004), 160–4.CrossRefGoogle ScholarPubMed
Lim, C H., Rotimi, , Dexter, O., SPL. et al. Randomized crossover study that used methylene blue or random 4-quadrant biopsy for the diagnosis of dysplasia in Barrett's esophagus. Gastrointestinal Endoscopy, 64 (2006), 195–99.CrossRefGoogle ScholarPubMed
Olliver, J., Wild, C. P., Sahay, P., et al. Chromoendoscopy with methylene blue and associated DNA damage in Barrett's oesophagus. Lancet, 362 (2003), 373–4.CrossRefGoogle ScholarPubMed
Jaramillo, E., Watanabe, M., Slezak, P., et al. Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy. Gastrointest Endosc, 42 (1995), 114–22.CrossRefGoogle ScholarPubMed
Kiesslich, R., Bergh, M., Hahn, M., et al. Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon. Endoscopy, 33 (2001), 1001–6.CrossRefGoogle ScholarPubMed
Brooker, J. C., Saunders, B. P., Shah, S. G., et al. Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomised controlled trial. Gastrointest Endosc, 56 (2002), 333–8.CrossRefGoogle Scholar
Sharma, P., Weston, A. P., Topalovski, M., et al. Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett's oesophagus. Gut, 52 (2003), 24–7.CrossRefGoogle ScholarPubMed
Messemann, H. and Probst, A.. Narrow band imaging in Barrett's esophagus- where are we standing?Gastrointest Endosc, 65 (2007), 47–9.CrossRefGoogle Scholar
Hammamoto, Y., Endo, T., Nosho, K., et al. Usefulness of narrow-band imaging endoscopy for diagnosis of Barrett's esophagus. J Gastroenterol, 39 (2004), 14–20.CrossRefGoogle Scholar
Sharma, P., Bansal, A., Mathur, S., et al. The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus. Gastroinest Endosc, 64 (2006), 167–75.CrossRefGoogle ScholarPubMed
Kara, M., Peters, F. P., Rosmolen, W. G., et al. High-resolution endoscopy plus chromoendoscopy or narrow-band imaging in Barrett's esophagus: a prospective randomised crossover study. Endoscopy, 37 (2005), 929–36.CrossRefGoogle ScholarPubMed
Sharma, P.. Magnification endoscopy. Gastrointest Endosc, 61 (2005), 435–43.CrossRefGoogle ScholarPubMed
Kumagai, Y., Inoue, H., Nagai, K., et al. Magnifying endoscopy, steroscopic microscopy and the microvascular architecture of superficial esophageal carcinoma. Endoscopy, 34 (2002), 269–375.CrossRefGoogle Scholar
Dinis-Ribeiro, M., Costa-Pereira, A., Lopes, C., et al. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest Endosc, 57 (2003), 498–504.CrossRefGoogle Scholar
Mayinger, B., Oezturk, Y., Stolte, M., et al. Evaluation of sensitivity and inter- and intra-observer variability in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus with enhanced magnification endoscopy. Scand J Gastroenterol, 41 (2006), 349–56.CrossRefGoogle ScholarPubMed
Fortun, P., Anagnostopoulos, G. K., Kaye, P., et al. Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett's oesophagus. Aliment Pharmacol Ther, 23 (2006), 735–42.CrossRefGoogle Scholar
Yagi, K., Nakamura, A., and Sekine, A.. Accuracy of magnifying endoscopy with methylene blue in the diagnosis of specialized intestinal metaplasia and short-segment Barrett's esophagus in Japanese patients without Helicobacter pylori infection. Gastrointest Endosc, 58 (2003), 189–95.CrossRefGoogle Scholar
Toyoda, H., Rubio, C., Befrits, R., et al. Detection of intestinal metaplasia in distal esophagus and esophagogastric junction by enhanced-magnification endoscopy. Gastrointest Endosc, 59 (2004), 15–21.CrossRefGoogle ScholarPubMed
Endo, T., Awakawa, T., Takahashi, H., et al. Classification of Barrett's epithelium by magnifying endoscopy. Gastrointest Endosc, 55 (2002), 641–7.CrossRefGoogle ScholarPubMed
Poneros, J.. Optical coherence tomography and the detection of dysplasia in Barrett's esophagus. Gastrointest Endosc, 62 (2005), 832–3.CrossRefGoogle ScholarPubMed
Kiesslich, R., Burgh, J., Vieth, M., et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology, 127 (2004), 706–13.CrossRefGoogle ScholarPubMed
Polgase, A., McLaren, W. J., Skinner, S. A., et al. A fluorescence confocal endomicroscope for in vivo microscopy of the upper- and the lower-GI tract. Gastrointest Endosc, 62 (2005), 686–95.CrossRefGoogle Scholar
Kiesslich, R., Dahlmann, A., Vieth, M., et al. In vivo histology of Barrett's esophagus and associated neoplasias by confocal laser endomicroscopy (abstract). Gastrointest Endosc, 61 (2005), AB101.CrossRefGoogle Scholar
Wong, R., Yazdanfar, S., Izatt, J. A., et al. Visualization of subsurface blood vessels by color Doppler optical coherence tomography in rats: before and after hemostatic therapy. Gastrointest Endosc, 55 (2002), 88–95.CrossRefGoogle ScholarPubMed
Li, X., Boppart, S. A., Dam, J., et al. Optical coherence tomography: advanced technology for the endoscopic imaging of Barrett's esophagus. Endoscopy, 32 (2000), 921–30.CrossRefGoogle ScholarPubMed
Kobayashi, K., Izatt, J. A., Kulkarni, M. D., et al. High-resolution cross-sectional imaging of the gastrointestinal tract using optical coherence tomography: preliminary results. Gastrointest Endosc, 47 (1998), 515–23.CrossRefGoogle ScholarPubMed
Bouma, B., Tearney, G. J., Compton, C. C., et al. High-resolution imaging of the human esophagus and stomach in vivo using optical coherence tomography. Gastrointest Endosc, 51 (2000), 467–74.CrossRefGoogle ScholarPubMed
Sivak, M., Kobayashi, K., Izatt, J. A., et al. High-resolution endoscopic imaging of the GI tract using optical coherence tomography. Gastrointest Endosc, 51 (2000), 474–9.CrossRefGoogle ScholarPubMed
Poneros, J., Brand, S., Bouma, B. E., et al. Diagnosis of specialized intestinal metaplasia by optical coherence tomography. Gastroenterology, 120 (2001), 7–12.CrossRefGoogle ScholarPubMed
Evans, J. A., Poneros, J. M., Bouma, B. E., et al. Optical coherence tomography to identify intramucosal carcinoma and high-grade dysplasia in Barrett's esophagus. Clin Gastroenterol Hepatol, 4:1 (2006), 38–43.CrossRefGoogle ScholarPubMed
Haringsma, J., Tygat, G. N., Yano, H., et al. Autofluorescence endoscopy feasibility of detection of GI neoplasma unapparent to while light endoscopy with an evolving technology. Gastrointest Endosc, 53 (2001), 642–50.CrossRefGoogle Scholar
Borovicka, J., Fischer, J., Neuweiler, J., et al. Role of autofluorescence endoscopy in surveillance of Barrett's esophagus: a prospective multicenter randomised trial (abstract). Gastrointest Endosc, 61 (2005), AB103.CrossRefGoogle Scholar
Kara, M., Smiths, M. E., Rosmolen, W. E., et al. A randomised crossover study comparing light-induced fluorescence endoscopy with standard videoendoscopy for detection of early neoplasia in Barrett's esophagus. Gastrointest Endosc, 61 (2005), 671–8.CrossRefGoogle Scholar
Kara, M., Peters, F. P., Kate, F. J. Ten, et al. Endoscopic video autofluorescence imaging may improve the detection of early neoplasia in patients with Barrett's esophagus. Gastrointest Endosc, 61 (2005), 679–85.CrossRefGoogle ScholarPubMed
Kara, M., Peters, F. P., Fockens, P., et al. Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in Barrett's esophagus. Gastrointest Endosc, 64 (2006), 176–85.CrossRefGoogle ScholarPubMed
Song, L.-M. W. K., Molckovsky, A., Wang, K., et al. Diagnostic accuracy of Raman spectroscopy for the classification of dysplastic lesions in Barrett's esophagus (abstract). Gastrointest Endosc, 63 (2006), AB89.Google Scholar
Eisen, G., Eliakim, R., Zaman, A., et al. The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices: a prospective three-centre pilot study. Endoscopy, 38 (2006), 31–5.CrossRefGoogle Scholar
Ramirez, F. C., Shaukat, M. S., Young, M. A., et al. Feasibility and safety of string, wireless capsule endoscopy in the diagnosis of Barrett's esophagus. Hepatology, 19 (2004), 433–9.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×